Health Care Reform and Diabetes

The American Diabetes Association issues the following statement on the health reform bill passing in the U.S. House of Representatives.

“Today is a day for celebration for the 23.6 million American children and adults who are living with diabetes. The passage of health reform by the House of Representatives finally tears down the wall that keeps people with diabetes from the health care they need,” commented Nash Childs, PE, Chair of the Board, American Diabetes Association.

“With the passage of health reform ‘just because you have diabetes’ will no longer be a lawful excuse to deny coverage, to charge exorbitant rates, or to take away care just when a person with diabetes needs it most. It gives all Americans with diabetes a fighting chance at controlling this devastating disease before they face blindness, amputation, heart disease, and kidney failure.

“The bill is also an essential step in the fight to stop diabetes through primary prevention using the tools we know can make a difference for the 57 million Americans with pre-diabetes and the one in three children who will end up with diabetes if our nation doesn’t change course.

“We thank the House of Representatives for their success in passing meaningful health care reform.”

Americans are urged to join the movement to Stop Diabetes

Starting on the 22nd annual American Diabetes Association Alert Day, the American Diabetes Association will encourage people to join the Stop Diabetes movement by taking the Diabetes Risk Test to find out if they are at risk for developing type 2 diabetes and, if they are at high risk, to speak with their health care provider.

The American Diabetes Association is leading the fight to stop diabetes and its deadly consequences and fighting for those affected by diabetes. The Association funds research to prevent, cure and manage diabetes; delivers services to hundreds of communities; provides objective and credible information; and gives voice to those denied their rights because of diabetes. Founded in 1940, our mission is to prevent and cure diabetes and to improve the lives of all people affected by diabetes.

Diabetes is a devastating disease that affects nearly 24 million Americans. Nearly 6 million Americans are unaware they have diabetes. An additional 57 million or one in five Americans have pre-diabetes, which puts them at greater risk for developing type 2 diabetes. If current trends continue, one in three children born today will face a future with diabetes.

Among the primary risk factors for type 2 diabetes are being overweight, sedentary, over the age of 45 and having a family history of diabetes. African Americans, Hispanics/Latinos, Native Americans, Asian Americans and Pacific Islanders are at an increased risk, as are women who have had babies weighing more than nine pounds at birth. Studies have shown that type 2 diabetes can be prevented or delayed by losing just 5-7 percent of body weight through regular physical activity (30 minutes a day, five days a week) and healthy eating.

The Diabetes Risk Test is available in English and Spanish by visiting www.stopdiabetes.com or calling 1-800-DIABETES (1-800-342-2383)

Screening for Diabetes Highly Cost Effective, Study Finds

Though some professional organizations recommend routine screening for type 2 diabetes, research now confirms it not only helps prevent or delay illness, it is also highly cost effective, according to a study commissioned by the American Diabetes Association being published today in the journal Lancet.

Using a highly detailed mathematical model, the study concluded that early screening could greatly reduce diabetes-related complications at reasonable cost and also substantially reduce mortality.

‘This study confirmed for us what we have long believed to be true but have never been able to show in clinical trials,’ said John Buse, MD, PhD, former President, Medicine and Science of the American Diabetes Association and an author of the paper.

Because there are few symptoms in the early stages of development, diabetes can go undiagnosed for up to 10 years, while rising blood glucose levels begin to cause damage to the body.

This can lead to costly and potentially devastating complications such as heart disease and stroke, kidney failure, blindness, and problems with the nerves, especially in the lower extremities, leading to risk of amputations. However, if blood glucose levels are properly controlled, people with diabetes can successfully prevent or delay complications of the disease.

That’s why the American Diabetes Association has long recommended that adults be screened for diabetes starting by at least age 45 and that the test be repeated every three years. Younger adults with diabetes risk factors, such as obesity or family history, should begin screenings earlier.

However, there have been no randomized, controlled trials to support this recommendation because such trials would be prohibitively expensive, requiring thousands of people without diabetes to be followed for decades.

This study, employing a complex and detailed mathematical model known as Archimedes, simulated 325,000 people matching the U.S. population in age, sex, health behaviors such as smoking, blood pressure levels, symptoms, medications and numerous other factors.

The simulated population underwent nine different screening strategies in sequence, ranging from no screening to beginning screening at age 30 and repeating every six months. The simulated patients were followed for 50 years or until they died.

All the screening strategies reduced rates of heart attacks and diabetes-related complications (such as blindness, amputation and kidney failure) and most reduced death rates. Compared to no screening, most of the strategies were highly cost effective, that is, the cost was $10,000 or less per quality-adjusted life-year (a year of perfect health) added as a result of the intervention.

Generally, interventions that cost less than $50,000 per QALY are considered cost-effective and worth recommending. The longer the wait to begin screening, the greater the cost. Waiting until age 45, for example, cost $15,000 per QALY gained, and waiting until age 60 cost $25,000 per QALY.

‘Clearly there is value to diabetes screening starting between the age of 30 and 45, as recommended by the American Diabetes Association, in terms of the quality of a person’s life due to earlier diagnosis and the ability to prevent complications,’ said Buse. ‘This model now suggests for us that there is a financial value to diabetes screening as well.’

The Archimedes model has been validated for accuracy by predicting the results of more than 50 real-life clinical trials.

New Inhaled Insulin Shows Promise for Diabetes

Serena Gordon Business Week

A new form of inhaled insulin help people with diabetes and pose fewer risks than Exubera‚ an earlier form of inhaled insulin no longer on the market.

Afrezza is currently awaiting approval from the U.S. Food and Drug Administration. It works faster, keeps blood sugar at levels closer to normal‚ and carries a lower risk of causing hypoglycemia than currently available‚ injectable insulin. Afrezza also has less risk of causing lung problems than Exubera. Using a new technology called Technosphere‚ Afrezza is inhaled as a dry powder that dissolves in the lungs‚ which then passes into the bloodstream and starts working quickly‚ peaking at 12 to 15 minutes after inhalation. This helps keep after-meal blood sugar levels lower and is less likely to cause a blood sugar crash later.

Baby Fat May Not Be So Cute After All

by Roni Caryn Rabin New York Times

Most anti-obesity efforts for youth have targeted schoolchildren and teenagers‚ but some studies show that interventions during the toddler years‚ infancy‚ and in utero may prevent obesity and lower the risk of diabetes.

One in 10 children under age two years is considered overweight, and the percentage of children ages two to five who are obese increased from 5 percent in 1980 to 12.4 percent in 2006.

Last year, an Institute of Medicine study began looking at obesity prevention in children ages zero to five years and examining sleeping, feeding patterns‚ and physical activity. One study found a link between gestational diabetes in the mother and diabetes in children among Pima Indians. According to the data‚ children born after the mother developed type 2 diabetes had a higher body-mass index in childhood‚ and they had a nearly four times higher risk of developing diabetes as siblings born prior to the diabetes diagnosis.